Medical Texts Lack Breastfeeding Information

< May. 07, 2008 > -- Doctors coaching new nursing mothers will find little practical advice to share from some of the classic obstetrics textbooks, a new study suggests.

Some of the texts omit key information for solving breast-feeding problems and others are inaccurate about the key steps involved, according to a study presented at this week's annual meeting of the Academy of Obstetricians and Gynecologists, in New Orleans.

Three of these "bibles" of obstetrics are not as "up-to-date or nearly as complete as they should be," contends study researcher Dr. Tony Ogburn, director of the department of obstetrics and gynecology at the University of New Mexico.

Dr. Ogburn believes that breast-feeding has been a neglected problem for some time, because some physicians have passed the buck - each seeing it as the provenance of another physician specialty, or of nurses who specialize as lactation consultants.

Mothers Need Information, Encouragement

While doctors in urban areas may be able to defer to lactation consultants, those who have a broader scope of practice in rural areas will miss the training they need on breast-feeding, adds Dr. Adam Aponte, chair of pediatrics and ambulatory care at Manhattan's North General Hospital. He was not involved in the new research.

Breast-feeding is not as easy as people think and "needs a lot of encouragement and support early on," he adds, and "with frustration, mothers can switch very quickly to the bottle."

On the other hand, gentle and accurate instruction about how to hold the baby to the breast properly can reduce some of the discomfort some nursing mothers experience, Dr. Aponte says.

The new review covered what the authors called "the five most popular obstetrics and gynecology textbooks based on sales." Dr. Ogburn gives two of the textbooks in the study - the 2003 edition of Maternal-Fetal Medicine, edited by Robert K. Creasy and Robert Resnick, and the 2007 edition of Obstetrics: Normal and Problem Pregnancies, edited by Steven G. Gabbe, et al. - high marks for providing complete and accurate information on breast-feeding.

Mistakes and Omissions

But he says doctors' "general lack of interest in breast-feeding is reflected in three other textbooks" - Williams Obstetrics, 2005 edition, edited by F. Gary Cunningham, et al., Danforth's Obstetrics and Gynecology, 2003, edited by James R. Scott, et al., and the 2006 edition of Beckmann's Obstetrics and Gynecology, edited by Charles R.B. Beckmann, et al.

"There's not the focus on it or interest that there should be," Dr. Ogburn contends.

In their review of five widely used textbooks, Dr. Ogburn, along with colleagues at Boston University, found the omission of key information and, in some cases, actual errors, he says.

For example, one text mistakenly advised that putting newborns on a feeding schedule is fine, while research shows that babies should be fed "on demand" - that is, whenever they are hungry, Dr. Ogburn says. Mothers sometimes fear that they will not have sufficient milk if they nurse too often, but nursing actually stimulates increased milk production, says Dr. Ogburn.

Another text also omitted a discussion of the inadvisability of supplementing mothers' milk with formula within the first 48 to 72 hours after delivery, Dr. Ogburn adds. Suckling is crucial in this postnatal period to stimulate the mother's breast milk. Meanwhile, nursing infants receive colostrum (especially healthy "first" or "immune" milk) from the mother's breast. Colostrum passes on the mother's immunity to the baby and protects it in the first month of life, Dr. Ogburn explains. He adds that mothers who supplement breast-feeding with formula during the first 72 hours are less likely to breast-feed later.

Spreading the Word

Dr. Ruth Lawrence, a professor of pediatrics at the University of Rochester who authored the breast-feeding section in one of the praised texts, says she and others have been trying for a number of years to increase the number of physicians who are well-informed about breast-feeding.

"Everybody knows that breast-feeding is good," Dr. Lawrence says. "But not everybody knows how to help mother succeed."

The Centers for Disease Control and Prevention's Healthy People 2010 goals and a policy statement from the American Academy of Pediatrics (AAP) recommend exclusive breast-feeding for the first six months, Dr. Ogburn says. Healthy People 2010 has set a goal for 50 percent of mothers to be nursing when their infants are six months old, compared with the 29 percent reported in 1998.

The benefits of breast-feeding for the child range from fewer upper respiratory infections to better bonding and lower rates of diabetes, Dr. Ogburn notes. And the AAP says that benefits to the mother include an earlier return to pre-pregnancy weight and a decreased risk of breast and ovarian cancer.

Always consult your physician for more information.

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Getting Started with Breastfeeding

The process of breastfeeding and your milk change as your baby grows and develops. A newborn's feeding routine may be different than that of a breastfeeding 6-month-old. As the baby grows, the nutrients in your milk adapt to your growing baby's needs. The anti-infective properties also increase if you or your baby is exposed to some new bacteria or virus.

The first weeks of breastfeeding should be considered a learning period for both you and your baby. Do not expect to work as a coordinated team immediately. Give yourselves plenty of time to recuperate from labor and birth, develop a daily routine, and overcome any initial breastfeeding difficulties.

Most full-term, healthy babies are ready and eager to begin breastfeeding within the first half hour to two hours after birth. Then, many sleep or act drowsy for the next two to 20 hours, so a baby may not be very interested in breastfeeding again on his/her birthday. However, a baby should breastfeed several times that first day. Expect to change only a couple of wet and dirty diapers during the first 24 hours.

Although he/she may need practice with latching on and sucking, by the second day, your baby should begin to wake and cue (show readiness) for feedings every 1½ to 3 hours for a total of 8 to 12 breastfeedings in 24 hours. These frequent feedings provide your baby with antibody-rich first milk, called colostrum, and tell your breasts to make more milk.

Your baby should suckle for at least 10 minutes and may continue for about 30 minutes on the first breast before letting go, or "self-detaching," without help from you. When he/she finishes at one breast, you can burp and change his/her diaper before offering the second breast.

As with day 1, you probably will change only a few wet and dirty diapers on baby's second and third days, and do not be surprised if your baby loses weight during the first several days. The number of diaper changes and baby's weight will increase when your milk "comes in."

You may feel uterine cramping when breastfeeding the first two or three days, especially if this is a second or subsequent baby. This is a positive sign that the baby's sucking has triggered a milk let-down, also called the milk-ejection reflex (MER). It also means your uterus is contracting, which helps minimize bleeding.

A nurse can give you something to take before feeding if needed for the discomfort. Some mothers briefly feel a tingling, "pins and needles," or a flushing of warmth or coolness through the breasts with milk let-down; others notice nothing different, except the rhythm of baby's sucking.

Because your baby still is learning, you may experience nipple tenderness when he/she latches on or during a breastfeeding. Other factors also may contribute to this tenderness, but usually it is mild and disappears by the end of the first week. If tenderness persists, develops into pain, or nipple cracking is noted, contact a certified lactation consultant (IBCLC).

Always consult your physician for more information.

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